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Aspen American Insurance Company

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Benefits 101



Benefits Plan 1 Plan 2 Plan 3
Plan Deductible Options $1,000, $2,500, $5,000, $7,500$1,000, $2,500, $5,000, $7,500$1,000, $2,500, $5,000, $7,500, $10,000
Coinsurance Options 70%, 80%, or 100%70%, 80%, or 100%70%, 80%, or 100%
Out of Pocket Maximum Options $2,000, $5,000$2,000, $5,000$2,000, $5,000, $10,000
Coverage Period Maximum Benefit Options $250,000, $750,000, $1,000,000$100,000, $250,000, $750,000, $1,000,000, $1,500,000$100,000, $250,000, $750,000, $1,000,000, $1,500,000
Additional Deductibles
Outpatient Surgery Additional DeductibleNo Additional DeductiblesNo Additional Deductibles$500 per surgery after which Plan Deductible and Coinsurance will apply. Maximum 3
Emergency Room Additional DeductibleNo Additional DeductiblesNo Additional Deductibles$500 per visit after which Plan Deductible and Coinsurance will apply. Deductible is waived if admitted to hospital
Advanced Diagnostic Studies Additional DeductibleNo Additional DeductiblesNo Additional Deductibles$500 per occurrence after which Plan Deductible and Coinsurance will apply.
Copayments
Doctor's Office Visit / Urgent Care Center$40 Copayment per visit, not to exceed a maximum of 3. Coinsurance is 100% of Eligible Expenses and benefits are not subject to the Plan Deductible. Office Visits in excess of the maximum number of Copayments will be subject to the Plan Deductible and Coinsurance. Any other covered services or tests performed as part of the office visit will be subject to the Plan Deductible and Coinsurance. The office visit maximum for all Doctor office visits, including any other covered services or tests performed as part of the office visit, will not exceed $2,000 per Covered Person per Coverage Period.$25 Copayment per visit per Covered Person. Coinsurance is 100% of Eligible Expenses and benefits are not subject to the Plan Deductible.$40 Copayment per visit per Covered Person. Coinsurance is 100% of Eligible Expenses and benefits are not subject to the Plan Deductible.
Wellness Benefit$50 Copayment for one annual Routine Physical Exam. Coinsurance is 100% and benefits are not subject to the Plan Deductible.$50 Copayment for one annual Routine Physical Exam. Coinsurance is 100% and benefits are not subject to the Plan Deductible.$50 Copayment for one annual Routine Physical Exam. Coinsurance is 100% and benefits are not subject to the Plan Deductible.
Advanced Diagnostic Studies CopaymentSubject to Deductible and Coinsurance.$500 Copayment per occurrence for Advanced Diagnostic Studies in an Outpatient setting, including PET, MRI, CAT scans not to exceed a maximum of 3 Copayments per Covered Person. Coinsurance is 100% of Eligible Expenses and benefits are not subject to the Plan Deductible. Occurrences in excess of the maximum number of Copayments will be subject to the Plan Deductible and Coinsurance.Subject to Deductible and Coinsurance.
Inpatient Hospital
Standard Room RateAverage Standard room rate. Benefits, including nursing services and all miscellaneous medical charges are limited to $1,000 per day.Average Standard room rate. Benefits, including nursing services and all miscellaneous medical charges are limited to $4,000 per day.Average Standard room rate.
Intensive Care or Critical Care UnitThe benefit payable for each day of confinement in an Intensive Care or Critical Care Unit. Benefits, including nursing services and all miscellaneous expenses, are limited to $1,250 per day.The benefit payable for each day of confinement in an Intensive Care or Critical Care Unit. Benefits, including nursing services and all miscellaneous expenses, are limited to $4,000 per day.The benefit payable for each day of confinement in an Intensive Care or Critical Care Unit.
Inpatient Doctor Visits$50 per day. Benefits for all Hospital visits during a Hospital stay are limited to $500 per Covered Person per Coverage Period.$50 per day. Benefits for all Hospital visits during a Hospital stay are limited to $500 per Covered Person per Coverage Period.Subject to Deductible and Coinsurance.
Emergency RoomThe benefit payable for each emergency room visit, including professional and facility services, will not exceed $250 per visit. (This includes the emergency room physician charge, 24 hours surveillance and all miscellaneous medical charges).The benefit payable for each emergency room visit, including professional and facility services, will not exceed $500 per visit. (This includes the emergency room physician charge, 24 hours surveillance and all miscellaneous medical charges).Subject to Additional Deductible shown above, then subject to Deductible and Coinsurance.
Outpatient Hospital Services
Outpatient Surgical FacilityThe benefit payable per day including all miscellaneous expense, is limited to $1,250.The benefit payable per day including all miscellaneous expense, is limited to $2,500.Subject to Additional Deductible shown above, then subject to Deductible and Coinsurance.
Outpatient Miscellaneous Hospital ExpensesThe benefit payable for miscellaneous Outpatient Hospital expenses, excluding Outpatient Surgery. Benefits are limited to $1,250 per Covered Person per Coverage Period for all Eligible Expenses combined.The benefit payable for miscellaneous Outpatient Hospital expenses, excluding Outpatient Surgery. Benefits are limited to $2,500 per Covered Person per Coverage Period for all Eligible Expenses combined.The benefit payable for miscellaneous Outpatient Hospital expenses, excluding Outpatient Surgery.
Other Covered Services
Surgeon$5,000 per surgery, for all Eligible Expenses combined, not to exceed $10,000 per Covered Person per Coverage Period.$10,000 per surgery, for all Eligible Expenses combined, not to exceed $20,000 per Covered Person per Coverage Period.Subject to Deductible and Coinsurance.
Assistant Surgeon and Surgical Assistant$1,000 per surgery, for all Eligible Expenses combined, not to exceed $2,000 per Covered Person per Coverage Period.$2,000 per surgery, for all Eligible Expenses combined, not to exceed $4,000 per Covered Person per Coverage Period.Subject to Deductible and Coinsurance.
Administration of Anesthetics$1,000 per surgery, for all Eligible Expenses combined, not to exceed $2,000 per Covered Person per Coverage Period.$2,000 per surgery, for all Eligible Expenses combined, not to exceed $4,000 per Covered Person per Coverage Period.Subject to Deductible and Coinsurance.
Extended Care Facility$150 per day not to exceed a maximum of 30 days per Covered Person per Coverage Period.$150 per day not to exceed a maximum of 30 days per Covered Person per Coverage Period.$150 per day not to exceed a maximum of 30 days per Covered Person per Coverage Period.
Home Health Care$50 per visit. There is a limit of 1 visit per day not to exceed a maximum of 30 visits per Covered Person per Coverage Period.$50 per visit. There is a limit of 1 visit per day not to exceed a maximum of 30 visits per Covered Person per Coverage Period.$50 per visit. There is a limit of 1 visit per day not to exceed a maximum of 30 visits per Covered Person per Coverage Period.
Hospice Care$2,500 per Covered Person per Coverage Period.$2,500 per Covered Person per Coverage Period.$2,500 per Covered Person per Coverage Period.
Ambulance
Injury$250 per transport$500 per transport$500 per transport
Sickness$250 per transport$500 per transport$500 per transport
Physical, Occupational and Speech Therapy$50 per day and 20 visits combined per Covered Person per Coverage Period.$50 per day and 20 visits combined per Covered Person per Coverage Period.$50 per day and 20 visits combined per Covered Person per Coverage Period.
Organ or Tissue Transplants$50,000 per Covered Person per Coverage Period$50,000 per Covered Person per Coverage Period$50,000 per Covered Person per Coverage Period
AIDS$10,000 per Covered Person per Coverage Period$10,000 per Covered Person per Coverage Period$10,000 per Covered Person per Coverage Period
TMJ$3,500 per Covered Person per Coverage Period$3,500 per Covered Person per Coverage Period$3,500 per Covered Person per Coverage Period
Kidney Stones$1,500 per Covered Person per Coverage Period$1,500 per Covered Person per Coverage Period$1,500 per Covered Person per Coverage Period
Appendectomy$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period
Joint or Tendon Surgery$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period
Knee Injury or Disorders$2,500 per Covered Person per Coverage Period for both left knee and right knee$2,500 per Covered Person per Coverage Period for both left knee and right knee$2,500 per Covered Person per Coverage Period for both left knee and right knee
Gallbladder Surgery$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period$2,500 per Covered Person per Coverage Period
Mental Disorders
Inpatient$100 per day, 31 day maximum per Covered Person per Coverage Period.$100 per day, 31 day maximum per Covered Person per Coverage Period.$100 per day, 31 day maximum per Covered Person per Coverage Period.
Outpatient$50 per visit, 10 visits per Covered Person per Coverage Period$50 per visit, 10 visits per Covered Person per Coverage Period$50 per visit, 10 visits per Covered Person per Coverage Period
Substance Abuse
Inpatient$100 per day, 31 day maximum per Covered Person per Coverage Period.$100 per day, 31 day maximum per Covered Person per Coverage Period.$100 per day, 31 day maximum per Covered Person per Coverage Period.
Outpatient$50 per visit, 10 visits per Covered Person per Coverage Period$50 per visit, 10 visits per Covered Person per Coverage Period$50 per visit, 10 visits per Covered Person per Coverage Period
Option of Waiver of Pre-Existing Conditions RiderYesYesYes